Abstract P-030: STANDARDIZING EARLY RECOGNITION OF HYPOTENSION REDUCES CLINICAL DETERIORATION AND SHOCK

Abstract

Aims & Objectives: Pediatric oncology patients are at high-risk for septic shock, which can progress to clinical deterioration or “rescue events”, requiring resuscitation and ICU transfer, and associated with increased mortality compared to other sources of ICU admission. Chart reviews revealed variability in care escalation, inconsistent use of fluid resuscitation, and frequent provider misinterpretation of systolic and diastolic blood pressures. Our goal was to reduce rescue events by early recognition of shock. Methods Age-based mean arterial pressure (MAP) norms, derived from our patient population, were integrated into the electronic medical record. Critical MAP thresholds were embedded within provider and nursing escalation guidelines of a septic shock pathway. Rescue events, defined as transfer to ICU, initiation of pressors and greater than 2 hours of hypotension, were measured over time. Results The revised septic shock pathway was implemented in December 2016. Baseline data (10/1/15 to 12/14/16) showed 25 rescue events (1.49 events per 1000 patient days), with reduction to 8 rescue events from 12/15/16 to 12/31/17 (0.56 events per 1000 patient days), a 68% reduction in events, and 63% reduction in the rate of events. Number of days between rescue events shifted considerably after implementation, with increased median days between events from 16 days (IQR: 7–22) to 56 days (IQR: 32–57), Figure 1.Conclusions Improved recognition of hypotension among high risk patients may lead to reduced morbidity and mortality. Next steps include spread of MAP thresholds to relevant clinical domains, including clinical pathways referring to hypotension (e.g. anaphylaxis, seizure management, eating disorders) and MAP-based resuscitation goals.